One of the most complicated and vexing areas of managing a practice of any kind arises from the interactions of people—whether pathologists, nonphysician laboratorians, or billing and administrative personnel. The billing process follows certain rules that are complicated and constantly changing, sometimes without notice. Calculating workloads is arithmetic (albeit controversial), but once a logical formula is established, measurement and comparison can occur. Human behavior, however, regularly balks at rules and confounds logic—a somewhat foreign and disturbing environment for some individuals. This chapter deals with a few of the major human resources (HR) functions within pathology organizations and attempts to provide practical methods and a pragmatic mindset for approaching them. Where differences exist between how pathologists and non-pathologists are recruited, managed, and retained, these will be noted, but often the same kinds of principles and problems are encountered in both groups, only on different pay scales and time frames. Pathologist employment agreements are more completely addressed in Chap. 12.

A characteristic of any successful organization is having the right people in the right jobs at the right time—a noble goal, but very difficult to accomplish. This concept is the essence of the well-known management book, Good to Great [1]. In the modern economy, talent (people) increasingly trumps capital in predicting success and survival. In fact, in the tech world, large companies may seek to purchase a smaller company more to potentially capture the personnel rather than add the acquisition’s book of business or technology. There are logical steps, however, that can be taken to improve the chances for operational success through optimal staffing. One step toward an effective hire is one of the most overlooked—a well thought out, well written job description . This is important for both pathologists and non-pathologists. Defining the position will provide you a solid concept of the content of the job, the skills and experience required to accomplish that job, and the characteristics and personality traits of the candidate that will complement your organization and its culture . A good job description also provides the candidate with an understanding of the job requirements and your expectations, thereby limiting post-hire surprises such as Dr. Szabo’s in the case above. If you find yourself struggling to find the right words or unsure if you have included the major duties, an online search for descriptions of like positions can be helpful, though this may be less valuable for professional positions. Other organizations have been hiring for similar positions for years and well-devised descriptions are often readily available online.

Many times an employee leaves a job early—either by resignation or by termination for “just not cutting it” in the eyes of a manager—due to the parties having differing concepts of the job. This causes disruption in the life of the employee and losses for the practice in the forms of faltering momentum toward reaching goals and the additional time (and money) spent in recruiting, selecting, and training replacements. These kinds of “mis-hires” are expensive to both the practice and the individual and need to be minimized (See Top-Grading [2] by Brad Smart).

The temptation to “get a warm body in the job” to alleviate volume pressures or associated overtime costs can be significant, but the right person in the job the first time, even if it takes a little longer, is the better long-term decision. This falls into the mistaken thinking of “not having the time to do it right, but having to make the time to do it over.” We have all been there.

In our competitive and resource tight world, look at the job functions being performed by your employees. Assess the level of talent required to efficiently do a job well. For example, a histotechnician or technologist may be needed for competent embedding or cutting of complex specimens, but less expensive skill sets can accession specimens, change solutions in processors, or operate automatic stainers. Matching skill sets to the requirements of the tasks allows for efficient operation of the laboratory and prevents payroll and related costs from being higher than necessary. Occasionally, a position may be designed with a mix of skill sets that would merit a higher salary scale, for example, for a known person such as an existing employee who is ready to move up.

A very good starting point for any employment search is a well-crafted job description.

Of the many sources for finding candidates for your organization, one of the best for providing longer-term successful employees is the network of people you already know and trust. For example, friends and colleagues of your current staff members are a good source, and your employees will generally want to refer candidates who reflect well on themselves and are a good potential coworker, providing a first-level filter of suitability. Next, do not overlook your own network of colleagues in other organizations, including vendors who have the opportunity to interact with people in targeted positions working for a variety of employers. In this regard, it is important to think of the recruiting/hiring process as being continual, or ongoing, so that you are always on the lookout for good people for future, if not current needs. Likewise, your business should be run in a way that makes others want to work for you.

For more recently trained pathology talent, contact academic program directors in good training programs. They will know the skills and abilities not only of those finishing soon but of graduates from the recent past, many of whom stay in touch and communicate when they are considering job changes. For harder-to-fill positions, whether due to the required skill or experience level, a recruiting agency (although seemingly expensive initially) may be worth the investment in finding the right candidate for your organization. They have a network of sources that generally far exceeds your own.

Keep in mind that depending on the size of your organization, you may be subject to a variety of state and Federal laws requiring steps be taken to ensure employment opportunity is offered to different candidates. Casting a wide net with your recruiting process (advertising in online sources and select print media such as industry periodicals or newsletters) can increase your candidate pool and help meet those employment goals.

Many books have been written on the unacceptable topics for job interview questions . The growing list generally includes such matters as health and physical abilities, religious preferences, gender or lifestyle choices, age, and more recently, questions on genetics.

What you can and should ask are questions that help you assess depth of expertise, honed skills, judgment, attitudes, and the cultural fit of the candidates. This is where that good job description comes in handy. The job duties and required skills and experience written in the description form a framework for developing interview topics. Specific questions should deal with the candidate’s experience and technical competence, problem and conflict handling skills, career goals (to ensure the position and company goals align with the candidate’s personal goals), and leadership experience when needed—all while assessing attitude and personality characteristics for a cultural fit within your organization .

Certain positions within the pathology practice or laboratory require specific degrees or certifications. Yet having the right educational pedigree does not always mean the candidate can do the job the way your organization needs or wants it performed. For pathologist positions, do not be fearful of causing offense by administering slide tests, including some form of report dictation. An ill-fitting hire can be avoided by having the candidate actually do the job you are hiring the person to do—for example, diagnose disease and dictate clear, succinct reports. This is perhaps the easiest part of the interview process. Harder to discern is attitude and cultural fit.

If more than one person is interviewing a candidate, consider the wisdom of scripting your responsibilities beforehand, perhaps even developing standard scenarios to use, so that a broader array of skills and perspectives can be seen. All individuals can still assess the degree of fit with the culture and core skills. Experience suggests that multiple interviewers using the more random “sit and chat” approach will more easily miss critical skill or attitude gaps than those using more organized or scripted approaches. Again, the job description can help guide the kind of script used by different parties. The detailed competency-based leadership scripted interviews described in Smart’s Topgrading [2] may seem onerous in a pathology practice that prides itself as being flexible and easygoing, but their reported success rate in finding “A-players” is difficult to ignore.

When positions are less dependent on specific degrees or certifications, consider the concept of hiring on attitude. Many skills can be taught on the job. A bright, hardworking individual who displays a positive, can-do attitude can add more long-term value to your organization than a highly disruptive genius.

Identify the purposes of your interview process, and verify that all involved know their roles.

The days of being able to rely solely on the representations of job candidates are well behind us. There are, unfortunately, job seekers who are willing to embellish accomplishments, stretch out tenures to cover gaps, and flat-out invent degrees, certifications, or other pertinent “facts.” This is true for professional candidates as well as others and while credentialing bodies will verify graduation and board and licensure status, it is costly to first discover those things at the stage of credentialing. As a prospective employer, you must not only check a variety of sources to validate information relative to experience and education, but your practice may also face increased liability for failing to perform certain checks. Your due diligence in this level of scrutiny will depend in part on which if not all of the potential “downsides” you are aiming to mitigate. You want a fully qualified and competent employee, one who will not be a safety risk to you or your clients, one who is trustworthy for the duties assigned, and who will represent you well to your customers and other employees. Again, taking the time to do things right the first time can save endless headaches down the road.

Work and educational history are verified by most employers these days, although it is getting increasingly difficult to verify much more from previous employers than dates of service and positions held. Legal claims from previous employees for unfavorable references have encouraged some employers to adopt a neutral reference policy negating the value appreciably. It is still worth making the calls, however, as even subtle hints can be picked up in the responses from prior bosses. One useful tool in this regard, particularly if you are conducting the reference check following a phone or other interview with the individual, is to ask the candidate whether the former employer or reference would rate them as an above average or superior performer. Then when speaking to the reference you can honestly state, “this person has said that you would rate their performance as above average/superior in their position. Can you confirm that?”